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        <jsp:param name="title" value="后台管理系统 - 用户管理"/>
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<form action="${domain}/admin/second/g" method="post"  onsubmit="return checkForm()">
    <div align="center" width="1000px">
        <td><input name="oName" type="hidden" value="${oName}"></td>

        <h4>表8  2016年自费疫苗情况调查表</h4>

        <table border="1" cellspacing="0" cellpadding="0">
            <tr>
                <td >疫苗名称</td>
                <td>品规</td>
                <td>接种数量（人次）</td>
                <td>接种单价（元）</td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=secondG[0] value="甲肝疫苗" type="hidden">甲肝疫苗</td>
                <td><input name="secondG[1]"></input></td>
                <td><input name="secondG[2]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[3]" type="number"  step="0.01"></input></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=secondG[4] value="乙肝疫苗" type="hidden">乙肝疫苗</td>
                <td><input name="secondG[5]"></input></td>
                <td><input name="secondG[6]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[7]" type="number"  step="0.01"></input></td>
            </tr>

            <tr>
                <td><input readonly unselectable="on" name=secondG[8] value="乙脑疫苗" type="hidden">乙脑疫苗</td>
                <td><input name="secondG[9]"></input></td>
                <td><input name="secondG[10]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[11]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[12] value="流腮疫苗" type="hidden">流腮疫苗</td>
                <td><input name="secondG[13]"></input></td>
                <td><input name="secondG[14]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[15]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[16] value="HIB疫苗" type="hidden">HIB疫苗</td>
                <td><input name="secondG[17]"></input></td>
                <td><input name="secondG[18]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[19]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[20] value="23价肺炎疫苗" type="hidden">23价肺炎疫苗</td>
                <td><input name="secondG[21]"></input></td>
                <td><input name="secondG[22]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[23]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[24] value="水痘疫苗" type="hidden">水痘疫苗</td>
                <td><input name="secondG[25]"></input></td>
                <td><input name="secondG[26]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[27]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[28] value="轮状疫苗" type="hidden">轮状疫苗</td>
                <td><input name="secondG[29]"></input></td>
                <td><input name="secondG[30]" type="number"  step="0.01"></td>
                <td><input name="secondG[31]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[32] value="IPV活脊灰疫苗" type="hidden">IPV活脊灰疫苗</td>
                <td><input name="secondG[33]"></input></td>
                <td><input name="secondG[34]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[35]" type="number"  step="0.01"></input></td>
            <tr>
            <tr>
                <td><input readonly unselectable="on" name=secondG[36] value="流感疫苗" type="hidden">流感疫苗</td>
                <td><input name="secondG[37]"></input></td>
                <td><input name="secondG[38]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[39]" type="number"  step="0.01"></input></td>
            <tr>
                <td><input readonly unselectable="on" name=secondG[40] value="狂犬疫苗" type="hidden">狂犬疫苗</td>
                <td><input name="secondG[41]"></input></td>
                <td><input name="secondG[42]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[43]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[44] ></td>
                <td><input name="secondG[45]"></input></td>
                <td><input name="secondG[46]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[47]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[48] ></td>
                <td><input name="secondG[49]"></input></td>
                <td><input name="secondG[50]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[51]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[52] ></td>
                <td><input name=secondG[53] ></td>
                <td><input name=secondG[54]  type="number"  step="0.01"></td>
                <td><input name="secondG[55]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[56] ></td>
                <td><input name="secondG[57]"></input></td>
                <td><input name="secondG[58]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[59]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[60] ></td>
                <td><input name="secondG[61]"></input></td>
                <td><input name="secondG[62]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[63]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[64] ></td>
                <td><input name="secondG[65]"></input></td>
                <td><input name="secondG[66]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[67]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[68] ></td>
                <td><input name="secondG[69]"></input></td>
                <td><input name="secondG[70]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[71]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[72] ></td>
                <td><input name="secondG[73]"></input></td>
                <td><input name="secondG[74]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[75]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[76] ></td>
                <td><input name="secondG[77]"></input></td>
                <td><input name="secondG[78]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[79]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[80] ></td>
                <td><input name="secondG[81]"></input></td>
                <td><input name="secondG[82]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[83]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[84] ></td>
                <td><input name="secondG[85]"></input></td>
                <td><input name="secondG[86]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[87]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[88] ></td>
                <td><input name="secondG[89]"></input></td>
                <td><input name="secondG[90]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[91]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[92] ></td>
                <td><input name="secondG[93]"></input></td>
                <td><input name="secondG[94]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[95]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[96] ></td>
                <td><input name="secondG[97]"></input></td>
                <td><input name="secondG[98]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[99]" type="number"  step="0.01"></input></td>
            </tr>
            <tr>
                <td><input name=secondG[100] ></td>
                <td><input name="secondG[101]"></input></td>
                <td><input name="secondG[102]" type="number"  step="0.01"></input></td>
                <td><input name="secondG[103]" type="number"  step="0.01"></input></td>
            </tr>
            <c:forEach var="h"  begin="104" end="243" step="4">
                <tr>
                    <td><input name=secondG[${h}] ></td>
                    <td><input name="secondG[${h+1}]"></input></td>
                    <td><input name="secondG[${h+2}]" type="number"  step="0.01"></input></td>
                    <td><input name="secondG[${h+3}]" type="number"  step="0.01"></input></td>
                </tr>
            </c:forEach>
        </table>
        <p align="left">
            注：</br>
            1、疫苗范围包括免疫规划内收费疫苗与计划外疫苗，同一疫苗涉及多个剂型、厂商的，可作为不同品规分别填报。</br>
            2、接种单价包括接种费和疫苗费。</br>
            3、如本机构无某一疫苗的接种，请在对应的单元格中填横线。</br>
            4、表中没有列出的疫苗，请在空行中补充。</br>
        </p>
        <button type="submit" ><b>提交并进入下一表格</b></button>


    </div>

</form>
</body>
</html>